Purpose of COOP

1. Continuity of Operations Planning for Public Health and Medical ServicesGreg MorganContingency Planner Stacy A. Robarge-SilkinerSNS CoordinatorKDHE Center for Public Health Preparedness

2. Purpose of COOP • Ensure the continued operation of organizations through a disaster (manmade, natural, technological) or a biological event (pan flu, anthrax, etc) • Facilitate the preparation of, site or activity specific plans and procedures that help ensure the safety of personnel • Allow organizational elements to continue essential operations in the event of an emergency or threat emergency. • Health System leadership will ensure that personnel are aware of their assigned COOP responsibilities via devolution of staffing concepts and just in time training.

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4. Hazard Vulnerability Assessment • Probability of an event occurring and the impact the event would have on departmental and system wide operations Clara Barton Hospital Hoisington, Ks www.redcross.org

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6. Hazard Vulnerability Tool • Allows individual health agencies to identify and rank various risk and mitigating factors • Coordinate with local law enforcement and emergency management • HVA Tool

7. Hazard Vulnerability Gap Analysis • Priority projects related to health agency emergency preparedness. • Interprets results of HVA into useable format • HVA Gap Analysis

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9. Assumptions and Considerations • COOP doesn’t apply to temporary disruptions of service • COOP plans will be operational within 12 hours • Maintain essential operations up to and beyond 30 days

11. Planning Essential Functions Delegation of Authority Order of Succession Alternate Facilities Interoperable Communications Public Information Vital Records Human Capital Security Logistics Training and Exercising Key Elements of COOP

12. Planning • Essential functions are listed and prioritized • Staffing requirements for each essential function are identified • Resource requirements for each essential function are identified • Critical data and data systems for each essential function are identified

13. Planning cont. • Support activities are addressed as part of essential functions • Plans exist for attaining operational capability within 12 hours • Processes and procedures exist to acquire resources necessary to continue essential functions and sustain operations for up to 30 days

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15. Procedures • Procedures for employee advisories, alerts and COOP/COG plan activation. • Provisions for personnel accountability. • Procedures exist for an annual review and revision of the COOP plan

16. Alert and Notification Procedures • Alert Procedures • COOP activation under any condition •  With Warning: • few hours warning • deployment of key personnel to a pre-determined location. • Notification methods • Without Warning: • Terrorist/bio-terror attack • Act of war • Natural disaster • Notification Procedures • Notify proper authorities of COOP activation • Notify the PT members  • Cell phone, pagers, blackberry, land-line, radio, etc

17. Essential Functions • Identification and prioritization of essential functions necessary for agency continuity of operations. Essential functions include services that are: • Loss of life • Public health and safety • Food and Shelter • 24/7 Direct Care and Critical Ancillary Providers • Economic impact • Symbolic value

18. Essential Functions agency specific • Define the agency mission and goals • Identify the functions that are needed to accomplish the mission • Identify the tasks to accomplish those functions • Identify the resources needed to support those tasks

19. Essential Function Prioritization • Essential Function Prioritization ranking • Critical- function cannot be delayed • Important- function can be delayed but should be resumed as soon as possible • Non-essential- function can be delayed until normal business operations resume

20. Public Health Essential Functions • Communicable Disease Containment • Immunization • Women, Infants, and Children (WIC) and Commodity Supplemental Food Program (CSFP) • Family Planning • Maternal and Child Health (MCH) • Child Care Licensing and Registration • Vital Statistics • Food Protection • Bioterrorism and Public Health Response • Human Resources • Fiscal Management • Public Information Officer (PIO) • Public Education • Home Health/Hospice/In-Home Care Program • Information System Support • Environmental Health

21. Hospital Essential Functions • Patient Care including triage and treatment for inpatient and outpatient recipients • Patient movement to care centers with appropriate levels of care for patients • Postmortem care and disposition with appropriate community partners • Patient tracking including medical screenings • Long term care of elderly and other fragile populations • Lab capabilities consistent with facility need • Medical billing for procedures performed • Patient decontamination and stabilization • Facility and personnel security for patients and employees • Meeting standards of care as required by State regulation or accrediting organization

22. Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

23. Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

24. Execution • Train successors and delegates identified for essential functions • Update contact information for all staff • 24/7 facilities must include a plan for: • Staffing • Medication and food supply • Medical assessment • Infection control • Communications

25. Execution • Provide devolutionof essential functions for operation • Identify: • Critical systems • Capabilities to perform essential functions due to staff depletion •  Logistical support •  Services and infrastructure alternatives •  Communications •  Related computer/software issues

26. Order of Succession vs Delegation of Authority • Order of Succession-list of individuals who would sequentially assume responsibility if the primary staff person is no longer able to carry out their functions • Delegation of Authority-positions in which the primary staff person has the authority to complete a particular task

27. Order of Succession • Order of succession should be established for the highest positions of authority. • i.e. Public Health Director, Hospital Administrator, Director of EMS • Line of succession should be established for the other leadership positions. • i.e. Infection Control Nurse, ER Head, • Limitations on delegate authority should be listed

28. Order of Succession • Rosters of trained/qualified personnel with the authority to perform essential functions and activities are maintained • Rules and procedures for implementing order of succession should be established • initiating conditions • notification methods • terminating conditions

29. Order of succession for essential functions • Three deep • Should include • Name and title • Point of contact information for 24/7 • Same successor may be named for different positions but avoid listing the same person as the first successor to several key positions

30. Courtesy of Doug Williams, St. Catherine Hospital, Garden City, Ks

31. Delegation of Authority • Delegation of Authority for each essential function should include: • Name and title of delegate • Position title and/or source of authority being delegated • Point of contact information (phone, cell, pager, email…) • Limitations (if any) or exceptions to the authority being delegated • Date or event that triggers delegation (Activation of COOP plan) • Date of termination or revocation (i.e. 30 day) • Name, title and signature of the official empowered to delegate the authority specified

32. Delegation of Authority to sign for Schedule Drugs

33. Command and Control • All response agencies are required to use Incident Command System (ICS) and follow National Incident Management System (NIMS) requirements (Hospitals use HICS) • Command staff provides overall coordination of the response and is the central communications point • Operations Section responsible for clinical duties including triage and treatment and directs all patient care resources • Logistics Section responsible for providing facilities, services (food, billeting, communications) and materials • Planning Section determines and provides for the achievement of each medical objective and manages human resources • Finance/Administrative Section responsible for maintaining accounting records, issuing purchase orders, and stressing facility wide documentation

34. Command and Control • Form an Operations Team (OT) for your COOP • Responsible for relocation activities • Ensure all necessary and pre-planned communications systems are established and functioning properly • Serve as the first shift operations at the alternate site • Provide cross training to personnel  • Utilize Job Action Sheets (JAS) and Just in Time (JIT) training • Employ call-down roster • Advise staff where to report • What to bring

35. Courtesy of Bob Hanzlick Lab Manager CMCI Colby Ks

36. Alternate Facilities • Alternate facilities may be needed in the event that the health care facility is damaged, destroyed or overwhelmed • In hospital terms: Alternate Care Site (ACS) • Site for hospital administration • Site for hospital patient care functions • Define ACS • Location for the delivery of medical care that occurs outside the acute hospital setting for patients who, under normal circumstances, would be treated as inpatients. • Site may provide delivery of chronic care, the distribution of vaccines or medical countermeasures, or the quarantine, cohorting, or sequestration of potentially infected patients in the context of an easily transmissible infections disease • In Health Department terms this could be a POD Mass Medical Care with Scarce Resources: A Community Planning Guide, Health Systems Research Inc.

37. Alternate Facilities • Consider: • level and scope of care to be delivered • foot print or size needed • staffing requirements • equipment and supplies • ICS structure needed to integrate this facility with other health facilities in the event • Security • Staffing • Communications • EMS and other transportation issues • rules/policies for operation • FMS, EMEDS, NDMS, Field Hospitals

38. Plan should identify: Logistical considerations (utility services, food, water, etc.) Pre-positioning of resources Hot site- pre-wired Cold site- needs installation Provisions for establishing interoperable communications with all identified essential internal and external organizations, critical customers and the public Provisions to sustain operations for a period of up to 30 days 24/7 Operations Considerations for the health and safety of relocated employees Physical security and access controls Co-location and duel use Formal agreements (MOU, MOA) Alternate Facilities

39. Lessons Learned from Katrina: Consider pre-planning and relationship building among agencies Use of ICS Public health (shower, toilets, amenities, hygiene) Security Transportation (EMS, self transported) Supplies (medical, pharmaceutical, food, water) Credentialing Staffing Patient tracking and documentation Communication Patient screening Pediatrics, geriatrics and psychiatric patients Accessibility to the public Special populations Alternate Facilities

40. Alternate Facilities • How to determine appropriate facilities • Alternate Care Site Selection Tool • Based on the Rocky Mountain Regional Care Model for BT Events • Kansafied • Do a Hazard Vulnerability Analysis • Determine population to be cared for at the designated site • Train and Exercise

41. Alternate Facilities • Challenges: • lack of regional/state planning with clear delineation of responsibility and authority • requirement that multiple entities work together who normally don’t • lack of inducements to write a plan train and exercise • licensing issues intra and interstate • funding • Standards of care- whole different presentation

43. Interoperable Communications • Hardware/software that talks to each other and people that can communicate with each other in the same language (no codes) • Systems that need to work together include radios, phones, faxes, email, notification systems, IT systems, software, secure data systems • People that need to work together include Hospital, Health Department, EMS, Fire, Law Enforcement, Emergency Management, Social Services… • Procedures and plans need to be written to specify how communication will work during COOP activation • Maintain the capability to communicate with internal and external clients, critical customers and the public.

44. Information Technology • Information Technology (IT) needs should be a component of each essential function • Consider during planning: • The essential function’s dependence on IT • Managing the IT infrastructure during COOP activation • Help desk tasks to support IT needs for identified essential functions • Ability to provide remote access to programs

45. Information Systems Support • Each essential service area must define their unique or critical information system requirements • Each essential service area must define their equipment needs and availability of this equipment • Where is it stored • How do we move it • Where do we get it if we do not have it • IT contingency plans • Designate responsible individuals/departments within the organization for moving and reestablishing IT • If relocation to an alternate facility is necessary, these services could be allocated to support organizations

46. Vital Records • Vital Records Include: • Emergency operating plans • Policy and Procedural records • Legal documents • Financial records • Personnel files • Patient records • Property management (inventory)

47. Vital Records • Provisions for classified or sensitive data • Procedures for data backup and restoration • Identify location and accessibility to vital records • How often are your vital records on computer backed-up? • Do you have back-up records for all of the paper based records at your facility? • Where are your back-up files kept? On site or off?

48. “With Planning and Preparation we ensure our safety today and preserve the future for younger generations” www.ksn.com/weather/weathergallery/wxphotos

49. Public Information Your most important tool will be Public Information! • Have trained back up PIO and spokes persons • Plan for working out of a different location (i.e. JIC) Have a go-kit • Maintain contact lists for media • Develop alternate methods of dissemination • Develop templates during pre-planning to avoid creating during an emergency • Message maps • Press releases • Information sheets • How to find alternate sites • Navigation of alternate sites (Signs)

50. Human Resources- HR Policies • Plan for a reduction in work force • Identify emergency policies for: • Overtime • Leave with pay • Leave without pay • Flexible leave options • Vacation time • Sick time • Identify plans for employees to work from home • Tele-work • Potential health and safety issues   • Liability assessment by general counsel • Union issues (overtime issues,disaster support, etc) • Training on contingency planning • Employee Assistance Program (EAP) for mental health and health insurance provisions